Download Introduction to the case

Name:
Daniel R. van Gijn
Professor: Stephen Dunne
University: King’s College London Dental Institute
Introduction to the case
A 23 year-old lady attended our Primary Dental Care clinic
concerned with the appearance of her teeth. She was a heavy
smoker with no medical history of note. She denied recreational
drugs. She had previously undergone orthodontic treatment.
The aetiology of her extensive caries was high sugar intake
combined with poor oral hygiene on a foundation of enamel
demineralisation secondary to previous orthodontic treatment.
As a motivator for improving oral health, we decided to restore
her upper anterior teeth using Ceram . X duo with an emphasis
on conservation of tissue.
Before
After
Post-operative Frontal view
All teeth were restored using
Ceram.X duo (E2/D3). All
contact points were maintained
throughout.
Pre-operative Frontal view
Rampant caries involving
upper anterior teeth.
Step 1-8 pictures are not mandantory.
You are allowed to delete not used
frames.
Step 1-8 pictures are not mandantory.
You are allowed to delete not used
frames.
Step 1-8 pictures are not mandantory.
You are allowed to delete not used
frames.
Pre-operative Left Lateral view
Pre-operative Right Lateral view
Pre-operative Frontal view
Intra-operative Frontal view
Extensive caries affecting upper left central,
lateral incisor and canine. All teeth were vital.
Note grossly inflamed gingivae.
Extensive caries affecting upper right canine,
lateral incisor and central incisor. Note
extracted upper right premolar (orthodontics)
and subsequent spacing.
Rampant caries involving all visible maxillary
teeth. Note improved gingival health following a
course of supragingival and subgingival scaling.
There had been a demonstrable reduction in
plaque scores.
Rubber dam, clamps and wedgets in-situ. Caries
removed on mesial and distal aspects of central
incisors. Lateral incisors and canines were
initially stablised with Glass Ionomer Cement.
Intra-operative Frontal view
Post-operative Right Lateral view
Post-operative Frontal view
Post operative view
Retraction cord placed on upper right lateral
and canine to facilitate exposure and moisture
control. Good EDJ clearance with residual
affected dentine overlying pulp chamber.
‘Veneer’ preparation to UR3.
Rubber dam in-situ. Note improved contact
points and mesial angulation of upper right
lateral incisor.
Rubber dam in-situ.
Cheek retractors in place. Note asymmetry of
gingival margins of upper central incisors.
Restorative work still required on lower arch.
Material and method
All teeth were restored freehand using Ceram.X duo Enamel (E2) and Dentine (D2) shade composites. Prior to restorative treatment, oral
hygiene instructions, dietary advice and fluoride adjuncts were provided. Supragingival and subgingival scaling were carried out concurrently.
All affected teeth were vital. Following careful caries excavation (ensuring the enamel-dentine junction was entirely caries free) tooth surfaces
were prepared using acid etch and Prime and Bond NT adhesive prior to layering of composite. Contouring was achieved with a diamond bur
and all restorations were finished using interproximal strips, enhance points and Sof-Lex discs.
Discussion and conclusion
The lady pictured above presented to our clinic anxious, embarrassed and dental phobic. Her extensive dental caries and
the subsequent affect that this had on her smile had dramatically curtailed her social life and general well-being. By
restoring her anterior teeth with Ceram.X duo, we managed to significantly improve her oral hygiene motivation and self
confidence. Restorative material technology allowed a conservative approach cavity preparation. The gingival asymmetry
of the maxillary incisors will be addressed with electrosurgery to the gingival margin of the upper right central incisor.
Monday, 13 February 12